Download Metabolic Disorders: Unit 10

Hepatitis
Inflammation of the liver
Caused by viruses, toxins, or chemicals. Drugs can cause hepatitis.
Jaundice
 A yellow pigmentation of the sclerae, skin, and deeper
tissues caused by excessive accumulation of bile
pigments in the blood.
 Bilirubin (bile pigment), a breakdown of Hemoglobin
of the red blood cell. (RBC) deposited in the skin and
excreted in the urine when high level are noted in the
blood.
 Etiology :
 Unconjugated
 Conjugated
Clinical Manifestations
 Yellow sclerae
 Yellow orange skin
 Clay colored feces
 Tea colored urine
 Puritis
 Fatigue
 anorexia
Outcome Management
Medical
Surgical
Determine the cause: LFT’s, CBC,
CMP and additional diagnostic studies
such as ultra sound, ERCP
Common Bile duct exploration
Nursing diagnosis
Tumor removal
Impaired skin integrity
Ineffective health maintenance
Disturbed body image
Hepatitis-Pathophysiology
 Inflammation of the Liver
 Multiple types
 A, B, C, D
 Viral, toxic, chronic or alcoholic
Hepatitis A
 Infectious Hepatitis-RNA virus
 Caused by:
 Infected water
 Milk
 Food
 Raw shell fish
Hepatitis B
 Viral
 Adults and Babies
 Transmitted via body fluids
 Can survive on environmental surfaces for at a least a
week
Hepatitis C
 Viral
 Usually identified when going to donate blood
 IV drug abusers account for 60%/Blood transfusion
 Tattoo and body piercing
Clinical Manifestations
 Vary from client to client-abrupt to insidious
Prodromal
Middle
Fulminant
Jaundice, lethargy,
irritability,
myalgia, anorexia,
N/V, abdominal
pain, diarrhea,
fever, flu like
symptoms,
pruritus
Encephalopathy,
liver flap, mild
depression,
bleeding
tendency, liver
enlargement,
palmar erythema,
gynecomastia,
acitis
Acute liver failure,
encephalopathy,
GI bleeding, DIC,
Hepatitis:
Medical Management
 Reduce fatigue
 Maintain nutritional and fluid balance
 Reduce effects of hepatitis
 Antiemetics, antihistamines, vitamin K,
glucocorticoids, estrogens, bile acid sequestrants,
immune globulin, vaccines
 Medications to avoid



ASA
Tylenol
Sedative-because of hepatoxic effects
Hepatitis:
Nursing Diagnoses
 Fatigue
 Imbalanced Nutrition: Less Than Body
Requirements
 Anxiety
 Ineffective Health Maintenance
Complications of Hepatitis
 Fulminant hepatitis- massive hepatic necrosis.
 Chronic hepatitis- inflammation> 3-6 months.
 Chronic hepatitis B- common among male
 Chronic hepatitis.
 Autoimmune hepatitis
 Chronic carrier state
 Aplastic anemia
Nonviral Hepatitis
 Toxic hepatitis and alcoholic hepatitis
 Etiology and risk factors

Chemicals, alcohol, medications
 Pathophysiology

Liver necrosis
 Clinical manifestations

same a viral hepatitis
 Medical and surgical management

Folic acid, thiamine, high carb diet, high vitamin,
parenteral fluids
 Nursing management
Hepatic Disorders:
Cirrhosis
 Cirrhosis overview
 Etiology and risk factors- associated with
alcohol ingestion.
 Pathophysiology – final stage of many liver
insults.
 Clinical manifestations- slow progression,
usually found during routine medical care.
 (Enlarged liver, abnormal labs)
 Medical management Monitor for complications
 Maximize liver function
 Treat the underlying causes and prevent infection
Cirrhosis: see concept map 1342-43
Nursing Diagnoses
 Ineffective Tissue Perfusion
 Imbalanced Nutrition: Less Than Body
Requirements
 Activity Intolerance
 Risk for Injury
 Ineffective Protection
 Ineffective Health Maintenance
Complications of Cirrhosis
 Portal hypertension
 Etiology and risk factors
 Pathophysiology


70% inflow portal vein
30% inflow hepatic artery
 Clinical manifestations


Acites, enlarged spleen,
esophageal varices
Portal Hypertension
 Hepatic encephalopathy
 Hemorrhage
 Sclerotherapy
 Transjugular
intrahepatic Porto
systemic shunt (TIPS)
 Vasopressin
 Beta-adrenergic–
blocking agents
 Balloon tamponade
Ascites: Management
 Correct fluid and
electrolyte imbalance
 Paracentesis
 Albumin
 Diet modifications
 Peritoneovenous
shunt
 TIPS
Hepatic Encephalopathy:
Medical Management
 Identify and treat cause
 Reduce nitrogenous/ammonia waste in blood
 Reduce bacteria in colon
 Maintain fluid volume balance